Hand Flashcards by Alegra Mendez

surface anatomy

palmar side
digital/proximal/palmar interphalangial crease
digital/proximal/thenar/wrist crease
thenar eminence 
hypothenar eminence

dorsal side
metacarpophalangeal joints (knuckles) 
extensor digitorum tendons
1st dosal interosseous m.
anatomical snuff box (radial pulse)

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total hand and wrist bones

27, not including sesamoid bones

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ligaments of hand

piso-metacarpal ligament
piso-hamate ligament
palmar radiocarpal ligament 
dorsal radiocarpal ligament
transverse carpal ligament (flexor retinaculum)

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which hand/wrist joints are hinge joints?

interphalangeal joint

- motion in only one direction (flexion/extension)

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which hand/wrist joints are condyloid joints?

MCP joints
aD/aBduction
flexion
extension
circumduction
axial rotation
(only in extended position)

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which hand/wrist joints are saddle joints?

1st carpometacarpal joint

aD/aBduction
flexion/extension
opposition
NO axial rotation

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arthrodial (sliding) joint

2nd-5th carpometacarpal joints

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ganglion cyst (synovial cyst)

benign swelling above joints (usually near scaphoid/lunate joint - 80%)

painless

bc of outpocketing/herniation of synovial capsule at a weakened region

50% recurrence post aspiration/surgery

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osteoarthritis

wear &amp;tear disease 
women>men
asymmetry
cartilage/bone loss
bony growths (Heberden's node, Bouchard's node) 
may or may not be painful

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AI disease
women>men
symmetrical
joint pain
ulnar deviation 
joint swelling (soft nodules)

boutonniere thumb deformity (PIP flexion, DIP extension)

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difficulty making OK sign

anterior interosseous nerve damage

Paresis of flexor digitorum profundus (lateral) and flexor pollicus longus.
a pinch instead due to weakened flexion of interphalangeal joint of thumb and distal interphalangeal joint of index finger

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fibrous and synovial digital sheaths

fibrous sheaths (cruciform and annular shapes)

digital synovial sheath
synovial sheath
- common synovial sheath (ulnar bursa)
- FPL sheath

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Inability to protonate could be due to

medial n. damage

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Outcrop muscles

APL
EPB
EPL
EI

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extensor pollicis longus

pivots on dorsal radial (Lister’s) tubercle

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central band

extends PIP

lateral band

extends DIP

unipennate lumbricals

1 and 2

bipennate lumbricals

3 and 4

boutonniere (“button hole’) deformity

via jamming finger, laceration, RA

CENTRAL band tears

lateral bands move ventral to PIP axis (via lumbrical/interosseous m. action)

relocated lateral bands –> hyperextend DIP and flex PIP as attempts are made to extend finger

mallet finger

ruptured extension tendon (where LATERAL bands insert onto distal phalanx)

intrinsic thumb muscles

abductor pollicis brevis
flexor pollicis brevis
opponens pollicis
aDductor pollicis

extrinsic thumb muscles

extensor pollicis longus
extensor pollicis brevis
aBductor pollicis longus
flexor pollicis longus

which thenar m. has superficial and deep heads? innervation?

flexor pollicis brevis

superficial head –> median nerve (recurrent branch)
deep head –> ulnar n.

superficial palmar arch of radial a. passes between which two thenar muscles?

opponens pollicis | aBductor pollicis brevis

deep palmar arch of radial a. passes through 2 heads of which thenar muscles?

through transverse and oblique heads of adductor pollicis

primary m. that flex the metacarpophalangeal joint

lumbricals

mallet finger

lateral band is avulsed from the distal phalanx

ulnar n. goes through ulnar tunnel and splits into ...

deep (motor) branch of ulnar n. superficial (mostly sensory, also supplies palmaris brevis)

if only recurrent branch of median n. damaged -->

thumb opposition lost

carpal tunnel syndrome: m. and skin affected

APB FPB (superficial head only) opponens pollicis 1st and 2rd lumbricals lateral 3.5 digits (palmar side) lateral, distal ends of 3.5 digits (dorsal side)

persistent median a.

(5-10% prevalence) norm regresses during fetal life recognized cause of carpal tunnel syndrome (usu due to thrombosed MA, anticoagulant therapy often clears sx) often assoc w/ bifurcated median n.

ulnar (guyon's) tunnel syndrome

compression of ulnar n. in ulnar canal (focal damage to myelin sheath: neuropraxia) MOI: pressure on ulnar canal (extended cycling) m. affected: all intrinsic hand m. EXCEPT 4.5 innervated by median n. deficits - opposition (weak ODM) - pinching (weak adductor pollicis) - loss of fine motor control skin affecetd - medial 1.5 fingers - paresthesia, pain - temporary recovery may be slow